Providing Cognitive-Behavioral and Mindfulness Digital Intervention for Community-Dwelling Older Adults through the COVID-19 Pandemic: A Randomized Controlled Trial

Background and purpose: Social distancing has been proven an effective method for reducing the spread of COVID-19. However, social contact is a fundamental human need, and limiting this vital drive during the pandemic can have far-reaching negative consequences for older adults’ mental and physical health. This randomized-controlled trial (RCT) evaluated the effects of a short-term cognitive-behavioral and mindfulness digital group intervention aimed at providing older adults with skills to promote improved coping and mitigate adverse mental health effects during the first wave of the pandemic.

Methods: This RCT, conducted March to June 2020, tested the effects of a guided intervention composed of seven online sessions using a small-group format. The intervention uses cognitive-behavioral and mindfulness techniques to target maladaptive beliefs and appraisals. Participants learned and practiced the techniques via the ZOOM videoconferencing platform. The sample consisted of 82 community-dwelling adult Israelis (ages 65–90 years; M=72, SD=5.63) who were randomized to either an intervention group (n=64) or a waitlist control group (n=18). Participants’ mental distress pre- and post- each session was monitored and assessed using the Subjective Units of Distress Scale (SUDS). Measures of loneliness (UCLA Loneliness Scale) and depressive symptoms (PHQ-9) were collected at three time points: baseline (pre-intervention), Week 3 (post-intervention), and Week 7 (1-month follow-up).

Results: The findings showed an average decrease of 32% in distress (SUDS score range 0–10), from a mean (SD) of 4 (0.14) at the beginning of a session to 2.7 (0.13) at the session end. A significant decrease in loneliness (score range 3-9) was observed in the intervention group from a mean (SD) of 5.4 (2.0) to 4.8 (1.7), (t(63)=2.15, p=0.03), with results maintained at 1-month follow-up (4.9, SD=1.8), (t(63)=1.5, p=0.27). Similar findings were observed for depression (score range 0-27), which decreased significantly from 6.3 (5.3) to 5.2 (4.7), (t(63)=2.57, p=0.008), and continued to decrease to 4.6 (4.1) at 1-month follow-up (t(63)=3.3, p=0.04). No significant changes were observed in the control group. Additionally, between baseline and post-intervention,10 participants (16%) assigned to the intervention group demonstrated a clinically meaningful decrease in depression (≥5 points); at the 1-month follow-up, this improvement was maintained by seven intervention participants (10%) whereas only 1 control participant (5%) maintained improvement.

Conclusions and implications: Our intervention presents a simple tool appropriate for wide use and implementation in various communities. The relevance of this intervention extends beyond the current pandemic because the skills acquired can be applied when individuals are facing other forms of crises as well as applied to routine life after the COVID crisis is controlled. In times of crisis or for the “new normal” of the post-pandemic, this intervention has shown value in promoting the mental health of older adults who live alone or who live in remote areas.